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BRIEF REPORT
Year : 2020  |  Volume : 68  |  Issue : 4  |  Page : 792--795

Impact of Prolonged Lockdown due to COVID-19 in Patients with Parkinson's Disease

Shweta Prasad1, Vikram Venkappayya Holla2, Koti Neeraja2, Bharath Kumar Surisetti2, Nitish Kamble2, Ravi Yadav2, Pramod Kumar Pal2,  
1 Department of Clinical Neurosciences; Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Pramod Kumar Pal
Department of Neurology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru - 560 029, Karnataka
India

Abstract

Background: The COVID-19 pandemic has compelled countries to impose lockdowns to curb the spread. As a result of the lockdown and need for health care services to cater to acute diseases on priority, patients with chronic illnesses such as Parkinson's disease (PD) may be facing several difficulties. Aims: This study aimed to explore the effects of prolongation of lockdown on patients with PD by evaluating possible problems faced during a lockdown and worsening of symptoms if any. Materials and Methods: One hundred patients with PD and their caregivers were contacted. Results: We observed a significant increase in problems faced due to this pandemic, specifically, the inability to access health care, and difficulty procuring medication. Patients also reported worsening of motor symptoms. Conclusions: The present findings highlight the need for health care systems to consider a plan of action for chronic neurological diseases like PD, which are worsening in the absence of regular hospital visits.



How to cite this article:
Prasad S, Holla VV, Neeraja K, Surisetti BK, Kamble N, Yadav R, Pal PK. Impact of Prolonged Lockdown due to COVID-19 in Patients with Parkinson's Disease.Neurol India 2020;68:792-795


How to cite this URL:
Prasad S, Holla VV, Neeraja K, Surisetti BK, Kamble N, Yadav R, Pal PK. Impact of Prolonged Lockdown due to COVID-19 in Patients with Parkinson's Disease. Neurol India [serial online] 2020 [cited 2020 Nov 26 ];68:792-795
Available from: https://www.neurologyindia.com/text.asp?2020/68/4/792/293472


Full Text



The COVID-19 pandemic has compelled several countries to impose complete lockdowns along with strict regulations for social distancing in an attempt to curb the spread of infection. The entire health care sector has been forced to adapt to this situation by incorporating a multitude of changes in the approach and management of patients.[1] Furthermore, the focus has been shifted to prioritizing care for acute illnesses. These factors raise concerns about the wellbeing of patients with chronic illnesses, such as Parkinson's disease (PD), who need regular hospital visits for dose adjustments. We had published our experience of ascertaining the perceptions and implications of COVID-19 in 100 patients with PD and their caregivers during the first phase of the lockdown in India.[2] This initial observation showed that most patients and caregivers were managing well, with a very small proportion reporting difficulties due to lack of access to health care and worsening of motor and nonmotor symptoms. However, considering the relatively short duration of lockdown prior to this survey, we anticipated changes in the event of an extension of the lockdown. In India, the lockdown was initially imposed for the duration of three weeks, and since then has been prolonged twice, to a current total of around eight weeks. The long-term implications of lockdown are unknown, and this study aims to explore the impact of prolongation of lockdown on patients with PD.

 Materials and Methods



A hundred patients with PD, and their caregivers who are under follow-up at the National Institute of Mental Health and Neurosciences, Bengaluru, India, were included in this study. As per hospital directives, patients were contacted telephonically for routine follow-up. Information was collected with a three-week interval between the baseline call and the follow-up call. Questions pertaining to perceptions about COVID-19 and PD, problems faced due to the current situation, and new/worsening of symptoms following the onset of the COVID-19 pandemic were selected from the questionnaire administered during the baseline evaluation.[2] Descriptive statistical analysis was performed for the demographic features of patients with PD and their caregivers. The Chi-square test was used to compare categorical variables, and P < 0.05 was set as the level of significance.

 Results



A total of 100 patients with PD and their caregivers underwent the follow-up assessment. The mean age of patients with PD was 58.06 ± 10.04 years, 70 were male, and the mean duration of illness was 5.35 ± 3.24 years. Similarly, the mean age of caregivers was 44.14 ± 13.79 years, and 51 were male.

There was a significant reduction in the number of patients (18% vs. 5%, P = 0.003) and caregivers (15% vs 3%, P = 0.005) who attempted to find out about interactions between PD and COVID-19 [Table 1]. Both patients (4% vs 18%, P = 0.002) and caregivers (6% vs 18%, P = 0.01) reported a significant increase in problems faced due to the current situation with the inability to access a health care facility, and difficulty procuring medication as the main inconveniences. A higher number of patients (11% vs 28%, P = 0.003) and caregivers (10% vs 26%, P = 0.005) reported worsening of symptoms. The most prevalent motor symptom reported by patients was the worsening of slowness. Neither group reported a significant increase in nonmotor symptoms.{Table 1}

 Discussion



These results suggest that our initial observations were the tip of the iceberg in understanding the impact of COVID-19-associated lockdown on patients with PD. To the best of our knowledge, although various commentaries[3],[4],[5],[6],[7] have discussed the probable short- and long-term implications of lockdown on PD, no study has longitudinally explored the impact of lockdown on patients with PD. The effect of early patient and caregiver education about COVID-19 and PD, which was imparted in the baseline call was evident in the reduction in attempts to look for interactions. This highlights the need for early patient and caregiver education about misconceptions. At the baseline evaluation, i.e., three weeks into the lockdown, we had observed that most patients were doing well. However, we suspected that the progression of lockdown would lead to an increase in motor and nonmotor symptoms. The worsening of motor symptoms at follow-up may be attributable to either the difficulty in accessing health care for a review of disease severity due to the absence of public transport, or the inability to procure medication refills, which could have compelled patients to ration the available medication. At baseline, a small proportion of patients had reported behavioral nonmotor symptoms in the form of stress and depression. A recent study administered the Beck Anxiety Inventory-II- Persian in patients with PD, their caregivers, and controls and reported the presence of severe anxiety in 25.5% of patients with PD, and 4.2% of caregivers. These results support our observation of anxiety in patients with PD.[8] Although worsening of motor symptoms was observed in our study, a corresponding worsening in behavioral nonmotor symptoms could be partly attributable to better acceptance and understanding of the pandemic situation, along with excellent family support provided by our sociocultural framework.

Although not explored in the present study, it is pertinent to discuss the impact of the pandemic on patients who have undergone deep brain stimulation (DBS).[9] The lockdown and restrictions placed to prevent the spread of COVID-19, have significant implications on both patients who have undergone DBS, and those scheduled to undergo surgery. DBS is considered as an elective procedure in several institutes owing to which planned surgeries have been put on hold. Such patients should be advised to continue the last optimized dose regimen, and surgery should be considered once restrictions are lifted. The larger burden of possible problems lies with patients who have already undergone DBS. These may be related to either the need for programming or drainage of the implantable pulse generator (IPG). Programming-related issues are more relevant in patients who underwent DBS shortly before restrictions were imposed. Typically, such patients would have undergone a detailed programming session to ascertain the ideal settings and corresponding medication adjustment. In the current situation, these patients should also be counseled to continue the presurgical dose of medication, and follow-up post for programming at a later date. In patients who already have an optimized DBS setting, with mild worsening of symptoms, medication may be optimized telephonically, with adjustment of programming parameters at a later date. The most problematic issue is drainage of the IPG, when patients may develop DBS withdrawal syndrome, wherein parkinsonian symptoms are often resistant to dopaminergic medication, and the condition may become life-threatening. In such situations, IPG replacement should be considered as an emergency with surgery planned at the earliest. We recently experienced such a situation, when two patients with PD not included in the present study presented to the emergency in an akinetic rigid state due to drained IPGs. IPG replacement was performed as an emergency surgery in both cases and dopaminergic medication was optimized. In other cases, with IPG drainage, drug adjustment with higher doses of dopaminergic medication may be tried to tide over the crises. All patients who have undergone DBS and are due for IPG replacement should be counseled about the need to check the battery status with the patient programmer and contact the treating neurologist if the indictor shows either a low battery or an end of service status.

Telemedicine services may prove to be highly beneficial in the current situation and if used judiciously may aid in the prevention of significant problems. Minor problems reported by patients can be addressed telephonically with counseling or dose adjustments. In the event of worsening patients should be suggested to visit a nearby physician or neurologist. Furthermore, patient education pertaining to COVID-19 and PD should be disseminated through print and social media to reduce apprehensions and misconceptions.

 Conclusions



The present findings highlight the need for better health care planning and implementation to cater to chronic neurological diseases like PD, which are worsening in the absence of appropriate expert advice from regular hospital visits. Timely interventions such as telemedicine may help mitigate this problem and prevent it from snowballing out control into a silent pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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